April 30, 2018
Broken or Fractured Teeth and Treatment Options
Pets with broken or fractured teeth are an extremely common presentation for veterinarians. We see at least one case daily, and several weekly. The large premolar and molar teeth are typically injured from chewing hard objects. The canine (fang) and incisor teeth are frequently fractured from trauma. In cats, it is particularly common to see fractured upper canine teeth. For cats in general, the canine teeth are most likely to fracture from facial trauma, while fractures from chewing objects is uncommon.
Teeth are fractured from chewing hard objects (see the first three photos below), from major trauma, and from less obvious trauma such as, pets fighting or playing. The extent of the fracture helps to determine a rational treatment plan. The extent of the fracture may be obvious, with vital (live) pulp exposure, or it may be more subtle. The non-vital (dead) exposed pulp is often not as apparent as calculus (tartar), which may cover up the fracture site. Additionally, the non-vital tooth may have the pulp chamber exposed without the bright pink or red pulp tissue visible. The extent of a tooth fracture may only involve the outer enamel, or it may involve deeper structures, such as the dentin or pulp (nerve and blood supply).
It is important to establish an accurate diagnosis prior to deciding on the best treatment for fractured teeth. Dental radiographs with periodontal probing allow for accurate diagnosis and optimal treatment plans.
Misconceptions and misunderstandings in veterinary dentistry are common. Some veterinarians are unfamiliar with modern dentistry and treatment options for teeth. Many pets benefit by saving teeth rather than extracting every tooth with problems. There are benefits in extracting teeth, as well as saving them.
We feel very strongly about providing thorough dental and oral surgery consultations. This allows for informed decision making.
Vital (live) tooth with recent tooth fracture. This dog refused treats. Complicated Crown Fracture.
Another pet with the same tooth fractured. Owner reports normal
eating and drinking habits, but not playful. Complicated Crown Fracture.
Complicated Crown Fracture.
This is a non-vital fractured tooth. It was completely covered by calculus. The
owner insisted the pet was "pain free" and without behavior changes until after
root canal therapy was performed. The owner was shocked to see a dramatic improvement in behavior after treatment.
Do fractured teeth hurt?
Fractured teeth hurt!
The anatomy, physiology and nervous system of our companion animals is incredibly similiar to our own. It is only logical to assume animals experience pain from fractured teeth. The degree of pain is related to the extent and duration of the fracture. If the pulp is exposed from an injury, such as being hit from a baseball bat or golf club, there is immediate and excruciating pain. Many times we fail to notice our pets have had fractured teeth.
As the tooth becomes infected through the fracture site, it may die and become non-painful. If the infection spreads to the alveolar bone supporting the tooth, pain often returns. The bone and local soft tissues may become infected and eventually abscess. The abscess may result in an intraoral swelling (inside the mouth), or an extraoral facial swelling (outside the mouth), and eventually become a draining tract. Swollen faces are tremendously painful in our experience with patients. We also notice that the pain is reduced when the abscess "bursts" and drains. These draining tracts may form intraorally or extraorally.
Treatment of fractured teeth eliminates the pain. Treatment also eliminates the swellings and draining tracts that sometimes develop.
Our experience has consistently been that pet owners are very surprised on how dramatic the improvement in their pets' behaviors are, abruptly after treatment has been provided. Many of these owners did not realize how painful their pets were until after we provided treatment.
What treatment options are available for fractured teeth?
Option 1: Extraction
Removing teeth is one treatment option, and it is the only option if the veterinarian does not have appropriate equipment, instruments, training, experience and interest in providing advanced dental care. There are times when extraction is the best treatment option, however there are times when extraction involves unnecessary risks for the patient. Risks associated with tooth extraction include: additional fractured teeth, fractured jaws, excessive bleeding and infection. At times, an extraction procedure may fail, and a tooth remnant is left in the alveolus, or end up in a sinus or other vital structure. The benefit of an extraction can be a rapid elimination of the problem.
We provide treatment options with disclosure of risks and the anticipated prognosis. These dental consultations allow for informed decision making for the pet owner.
Option 2: Endodontic Therapy (root canal therapy or vital pulpotomy therapy)
Root canal therapy and vital pulpotomy with pulp capping, are two treatment options for fractured teeth. The family veterinarian typically does not offer these services because of their focus on more common needs for companion animals. They have made decisions to invest wisely in technology that allows them to offer optimal general care for your pets. It is not fair to expect the family veterinarian to invest time, effort and money in services of lower demand. The quality of endodontic service is compromised when the operator only gets the opportunity to do 10 or 12 root canal treatments a year. Equipment, training and experience makes a huge difference in providing successful services. You can count on them to save your pet's life, and refer your pet to us for endodontic therapy.
Endodontic procedures require: specialized training, equipment, instrumentation and clinical case experience. Not every upper fourth premolar tooth has the same root canal anatomy or orientation. Not all teeth have the same number of roots or anatomy. Young pets tend to have very wide canals. If they are too young, root canal therapy may be contraindicated. In those cases, vital pulp therapy may be appropriate. With the wide variation in patients (180# Great Dane to the 1.4# tea cup Yorkie) we see, there is a demand for a wide assortment of equipment and instruments. Not all endodontic procedures are performed using the same technique or materials. The high volume of cases we see improves our efficiency, patient safety, and the overall success rate.